Previously I’ve spotlighted the Medicaid member “churn” phenomena and have advocated for improvements to keep people who are eligible for Medicaid from getting bounced on and off coverage. The churn issue is important because it results in fragmented care, and burdens safety-net health care providers and medical homes, MMCOs, and the state with the time and effort to re-enroll these members.
As Commonwealth Care moves beyond its freshman year and into a maturing program, the same eligibility redetermination process is now being applied to its members — with disquieting results.
The redetermination process kicked off in December. At Network Health, we have subsequently seen 12,000 Commonwealth Care members involuntarily disenrolled in February and March, nearly three times the previous disenrollment rate.
To put a human face on these numbers, I can offer an unfortunately “spectacular” story of one of our Commonwealth Care members who has lost his Commonwealth Care coverage not once, but twice since his enrollment last spring. This man was asked for citizenship documentation, which he provided three times by fax and mail. While continuing to pay his premium, he inexplicably lost coverage, leaving him to pay a steep $400 monthly prescription bill, in addition to other medical bills. He also missed medical appointments due to his lack of coverage as he didn’t feel it was appropriate to present for care without health insurance. He was finally re-enrolled in Commonwealth Care a few months later, only to be again disenrolled after a month of coverage, this time with his wife, for allegedly having access to employer-sponsored insurance (ESI). Unfortunately (but predictably), this was erroneous information, as they did not have access to ESI; their small employer apparently had once offered coverage to employees, but no longer does. They are both currently uninsured, trying to re-enroll.
We would be delighted to hear that the majority, if not all, of our involuntarily disenrolled Commonwealth Care members had gained access to employer-sponsored insurance or other public-sector insurance, or had increased their income to move into the Commonwealth Choice market. However, this one example echoes consistent trends of members being disenrolled for returned mail, failure to complete paperwork on time (often out of confusion or belief that they have previously answered the questions), or miscommunication about the presence of employer-sponsored insurance.
Sweeping administrative disenrollments result in gaps in coverage that disrupt continuity of care for people who still meet eligibility requirements — people for whom the program was intended. They are also detrimental to the providers serving as “medical homes” who are working to organize care and services for these members and their communities. We continue to have data that support that a large number of individuals involuntarily kicked off publicly funded health insurance programs are eligible for the programs at the time they are terminated. I’m a supporter of the saying, “Always make new mistakes,” but why do we choose to make the same ones over and over? Doesn’t this data support that the process lacks legitimacy when we know that the largest affected cohort is incorrectly classified as ineligible? I’m all for having a strict process — one that is tough on fraud and abuse, and one that uses a thoughtful and diligent process to manage beneficiary eligibility. However, the current process, which is based on a guilty-until-proven-innocent premise, does not serve to protect the interests of state beneficiaries at large.
Christina Severin is executive director of Network Health, a health plan with more than 160,000 MassHealth and Commonwealth Care members across Massachusetts.
Thank you for making such a clear case, Christina. I know outreach workers are struggling to keep people covered and maintain access to care, and report it is increasing difficult to do so. At our last HAN meeting, we wrote about forms and processes that are new to seasoned workers.
Where is the outrage about this ridiculous health insurance system??? The Chapter 58 law only attempted major tinkering with a horribly flawed and broken system. Yes, it did do some helpful things for some people but did them in a way that is wasteful, expensive, unsustainable and often ineffective. This post ignores the horrors of the new individual mandate that forces state residents to purchase expensive private health insurance or be fined close to $1,000 annually (the state is saying “too bad for you” to the many residents who are trying to keep up with paying for the mortgage/ rent, heat, medicine, and food).
On full balance, the Chap 58 law does more harm than it does good and I am far from alone in that assessment.
Many, many other health professionals from all disciplines, policy makers, and state residents from all walks of life share these concerns. I know that we also want to be a part of crafting a real and lasting solution, one that will bring us in line with every other industrialized democracy in the world. Only the U.S. has not created some form of a national health program that is equitable, affordable, and functional. This disgraceful fact stands alongside the facts that we spend twice as much per person on our broken system yet achieve far poorer health outcomes for our entire population.
Here’s the rub: A workable solution – on the state or national level – requires courage and leadership from politicians and from people like Christina Severin, John McDonough from Health Care For All, and Nancy Turnbull, who is past president of the MA Blue Cross Blue Shield foundation and seems to be a very smart and caring policy advocate, to acknowledge that one of the biggest elephants in the parlor blocking our way to needed reforms is the private insurance industry. And then do something about it.
Where is the leadership that Massachusetts and the nation so desperately need on this issue??? Perhaps Barack Obama will be one of these leaders, and it looks like his friend Deval Patrick is poised to help lead us there as well. What a wonderful legacy that would be.
A recent Op-Ed in the Berkshire Eagle quoted Governor Deval Patrick as saying: “…there’s a view out there that as long as private insurance is a part of health-care reform, we’re never really going to break the back of the pattern.” He called for serious consideration of a single-payer universal health care solution by the next administration in Washington.”
for info on health reform that puts people before profits visit
http://www.MassCare.org/about
http://www.HealthCare-Now.org
and
http://www.DefendHealth.org
I hope readers didn’t miss this terrific bit of irony:
“The redetermination process kicked off in December. At Network Health, we have subsequently seen 12,000 Commonwealth Care members involuntarily disenrolled in February and March, nearly three times the previous disenrollment rate.”
Instead of parsing the words with disenrollment and the like, a more honest statement would have been:
“…we have seen 12,000 people kicked off their access to health care…”
Instead of honest and straight-forward discussion about this mess called the Chapter 58 law what we get is more churn, churn, churn of the facts. This is tragic because it takes us farther and farther away from crafting and implementing a workable solution to the health care crisis. This crisis is killing and maiming more people than most of you readers would ever imagine – I know because I lost my mother to it.
Under Funded and Un Affordable = Un Workable and Un Manageable
It has got to be getting embarrassing for the political leadership in MA. Their health care financing reform initiative is a national joke. Here’s a news flash to the Patrick administration and the Board of the Commonwealth Health Insurance Connector. This is what happens when you
pass health care financing reform legislation and then decide to fill in the gaps later. If you attempt to reform a health care financing system before you have strong legislation, a strategic implementation plan and firm commitments from all stakeholders as to their roles, responsibilities, and financial commitment, it will FAIL.
Hi Tim – would it be too intrusive to ask you to share your mother’s story?
Thanks, Martha Bebinger
In response to Tim and Tom Garvey;I’d like to thank you for your post.Close to two years now myself and others have been trying to get the truth out about chapter 58.The facts are the state does not know how many are uninsured or how much this will cost which to me is putting the horse before the cart but to mandate and fine citizens for not buying into medical insurance with $2000.00 to $4000.00 deductables.How do the legislators get away with this?The uninsured are not uninsured by choice but because of the cost it is impossible to afford.
To Ms Bebinger and others,
My mother was not able to afford health insurance. Over the years she did not always get it through her work. She battled serious depression and would be better when she could get care. She took medication when she was having a relapse. When she had her last relapse she could not get good mental health care and could not afford her medicine. She committed suicide. When I read about so many veterans from Iraq who come home and don’t have mental health care and commit suicide I think of my Mother and ask what will it take for this state and this country to do the right thing and make good health care a human right for all of us.
Christina,
You have made a good case for the incompetency of the Connector and how people who are trying to comply with this law are being hurt.
However, I agree with Ann E. Malone that you have failed to acknowledge the rest of the ugly story: there are at least *300,000 hard-working taxpayers who have had their personal exemption(s) stolen by the Connector because they couldn’t afford the so-called “affordable” insurance. Many of these folks are having difficulty paying their bills and still have no insurance while their penalties pay for the freebie crowd. Meanwhile, monthly penalties are accruing.
*678,000 uninsured per MA Budget & Policy Center, Aug. 28, 2007 and per the Connector’s numbers (which have a tendancy to be inflated when it comes to enrollment and underestimated with regard to the number of uninsured) 340,000 insured but probably less because thousands have dropped coverage due to affordability issues.
The number of drops will continue to grow as the economy worsens and the 10% higher premiums and double copays for Commonwealth Care go into effect on July 1. There will also be more penalty-payers due to the fact that many residents won’t be able to afford to upgrade policies to meet minimum creditable coverage.
Forcing people to choose between food, heat, the roof over their head, property taxes and other core-living expenses and health insurance they cannot afford or penalties they cannot afford either is a crime.
The stress caused by this is extremely unhealthy and is further exacerbated by having to intentionally earn less money to either obtain less expensive insurance or lower penalties in order to survive this sham reform until it crashes and burns. May this happen sooner than later.
It is my opinion that Deval Patrick would not necessarily stand behind his words in the Berkshire Eagle op-ed piece because my experience in speaking with him and reading articles in which he has been interviewed tell me a different story. He has a tendancy to jump from one side of the fence to the other depending on the “audience.” It is my belief that his motives are purely political and not in the best interest of the people in this state.
A letter with specific and important concerns regarding this law and its effect on residents was hand-delivered to him – literally put in his hand and acknowledged by him. This was on January 31. He has yet to respond despite calls made to his office requesting the status.
Tim,
I am sorry to hear about what you, your family and your mother went through. This kind of situation should have never happened in the “richest” nation in the world nor should our Iraqi vets be subject to the lack of medical and mental health care they so desperately need. They should not be left homeless either.
Martha,
In case you are interested in a horror story: An acquaintance enrolled in December. She received a temporary form and was told her policy would arrive in the mail. She became ill while on the road (in MA) and had to be taken by ambulance to a hospital where she was diagnosed and given medication, then sent on her way. She remained very sick and went to stay with relatives in another state for a few weeks.
Upon her return, she expected to find her Commonwealth Care policy in the mail but instead, there was a pile of bills: the ambulance, hospital, doctors and medication. She made phone calls and was told she had no insurance. She continued to make calls but to no avail. She was still very sick and knew she needed to find a doctor. After calling 7 doctors, she finally found one who would take Commonwealth Care patients. This doctor was an hour one-way and unknown to her. Because she was still considered unenrolled by the Connector (even though she had enrolled and was paying premiums) she was self-pay at this doctor’s office AND was also a new patient, so the visit cost more. She was told she needed an expensive test but would have to pay for it, so she left without the test.
About 2 months later she was told that the Connector would consider her covered starting in April, that the event at which enrolled was for “getting started” only, and in the meantime, the Safety Net would pay some of her bills. So far the Safety Net has paid nothing as there has been a total lack of communication between that entity and the hospital. The Safety Net doesn’t cover ambulance, doctors who are not employed by the hospital or medication so her bills were put into collection, ruining her stellar credit.
To date she has not had the test, she is still sick but going to work because she has to earn a living, the bills remain unpaid by the Safety Net and the Connector will do nothing to help her. I made some calls and found one advocacy group that might be able to help her and have not heard from her if she has received any relief.
Take your pick – either one applies to what is going on in MA with regard to the mandated health insurance law:
“One who uses coercion is guilty of deliberate violence. Coercion is inhuman.” – Mahatma Ghandi
“Coercion cannot but result in chaos in the end.” – Mahatma Ghandi
[...] by Christina Severin Posted by CommonHealth, Tuesday, July 29th, 2008 As you know from my previous posts, the “churn” of still-eligible MassHealth and Commonwealth Care members on and off their [...]